Colposcopy and cervical biopsy Patient Information

A colposcopy procedure is a detailed assessment of the cervix (neck of the womb) using a microscope. The most common reason for needing a colposcopy is following an abnormal cervical smear test or having persistent post-coital bleeding. The procedure usually takes about 15 minutes and is almost always done in the clinic setting as an out-patient. It is a very safe procedure and does not carry any significant risks.

In order to get the best views of the cervix, you will be asked to lie on a couch with your legs in padded supports. First, a speculum is inserted into the vagina (the same instrument that is used to take your cervical smear test). Liquid solutions on cotton wool are applied to the cervix which highlight any abnormal pre-cancer cells. This can sometimes result in a tingling sensation. Your doctor will then perform a detailed examination using the colposcope and will be able to tell you what they find.

If it is obvious that a treatment to remove precancerous cells is required, you will be offered the treatment there and then (see Loop Excision of Cervix Patient Information).

If there is a suspicion of pre-cancer of the cervix, it may well be necessary to take a biopsy for analysis in the laboratory. This is a very quick procedure where a tiny sample of cervix (about the size of a grain of rice) is removed. It is not usually painful but can be rather like a pinch. Taking a biopsy can be associated with a small amount of bleeding and a paste is usually applied to the area biopsied to stop any bleeding. You may notice the paste as a brown discharge and it is common to have some light bleeding for up to five days following a biopsy.

Following a colposcopy you will be able to resume normal activities immediately. If you have had a cervical biopsy you should wait until the discharge and bleeding has stopped prior to resuming intercourse or using tampons. Get in touch with your doctor if you have persistent, heavy bleeding or an offensive vaginal discharge as this may indicate you have an infection.

The biopsy results take approximately two weeks to be processed and your doctor will inform you of the result. The result will determine whether any treatment is necessary.

Hysteroscopy Patient Information

This is a camera test of the endometrium (lining of the womb). It is a useful test to investigate bleeding after the menopause, unusual vaginal bleeding, heavy periods or pelvic pain. It is possible to diagnose and remove benign growths such as polyps and fibroids. It is also useful to retrieve embedded coils. A hysteroscopy procedure can be done in theatres under general anaesthesia or as an out-patient with local anaesthetic. When performed under general anaesthesia it is nearly always as a day case, meaning you go home on the same day and there is no need for an overnight stay.

A hysteroscopy allows your doctor to visualise inside the womb. A narrow telescope with a camera at the end is passed through the vagina and cervix into the womb. There are no cuts to your skin. Your doctor can see the image on a screen. It is usual for a biopsy to be taken at the same time and if a polyp is identified it can usually be removed (called a polypectomy).

All procedures carry small risks. The main risks during a hysteroscopy are bleeding and infection. It is normal to have some bleeding following the procedure but if the bleeding is very heavy you should seek medical advice. Heavy bleeding, offensive vaginal discharge and a fever are all signs of infection and you should see your doctor for antibiotics if this happens. Rarely, the instruments used may cause damage to nearby structures such as the neck of the womb, the bowel or bladder. Any damage caused would need to be repaired and this may involve a cut on your abdomen.

Following the procedure you may experience some period-like pains and you can take your usual painkillers (such as paracetamol and ibuprofen). This should settle after a day or two. Most women feel normal the following day. You should avoid intercourse until the bleeding has stopped.

If a biopsy was taken or a polyp removed, it takes approximately two weeks for the laboratory to process the specimen. Your doctor will get in touch once the results are available.

Intrauterine System (IUS) - the hormone coil

The IUS delivers a small amount of the hormone progestogen into the womb every day for up to five years. It is a small, plastic T shaped device that your doctor inserts through the vagina and cervix so that it sits in the womb.

The IUS is an excellent contraceptive (more than 99% effective), but it does not protect against sexually transmitted infections. It works by thickening the cervical mucus so sperm cannot pass through the cervix easily. It also keeps the lining of the womb thin, making implantation difficult and, in some women, may also prevent ovulation.

The IUS is a very effective way of managing heavy, painful periods. It prevents the lining of the womb from thickening and so women only tend to have very light periods or have no bleeding at all.

Fitting an IUS can usually be done in the clinic setting. Some women find the procedure uncomfortable and there is always an option of using local anaesthetic if necessary. First, your doctor will examine you to assess your womb. A speculum instrument is placed into the vagina (the same instrument used for taking a cervical smear test). The IUS is passed through the cervix and sits at the top of the womb. There are two fine threads that are cut just below the cervix. The threads are important for removing the IUS and you may well be able to feel them yourself. They should not have any impact on intercourse.

Some women get period-like pains for a few days following insertion of an IUS and should take some simple painkillers such as paracetamol and ibuprofen. Your doctor will check the position of the coil 4-6 weeks after the fitting.

Having an IUS fitted is very safe but, as with all procedures, there a few risks. The most common risks are bleeding and infection. See your doctor if you develop an offensive vaginal discharge as this may indicate an infection and you may need antibiotics. It is normal to have bleeding after an IUS and the bleeding may last several months. It is usually light bleeding and spotting. Rarely, an IUS can be rejected (fall out) or can migrate (make a hole in the womb and travel into the abdomen). For these reasons it is important that your doctor checks the position of the IUS after it is fitted.

You are very unlikely to get pregnant with an IUS in situ but you should use additional contraception for the first seven days after fitting. If you do get pregnant, you have a increased chance of an ectopic pregnancy and so consult your doctor in this scenario.

Loop Excision of Cervix Procedure

A loop excision of the cervix (also termed LLETZ) is an operation to remove pre-cancerous cells from the cervix (neck of the womb). It is required when women have high grade changes on their cervical smear. Treatment prevents these changes progressing to a cancer over time. It can also be offered to women that have persistent low grade abnormalities (mild changes that do not resolve with time).

A loop excision of the cervix is usually performed as an out-patient procedure with local anaesthesia but sometimes it is necessary to do it in theatre under general anaesthetic.

First, your doctor will perform a colposcopy examination (see Colposcopy and cervical biopsy patient information above). Once the abnormal cells have been identified, local anaesthesia is injected into the cervix to make the area numb. A thin wire loop with an electric current is then used to excise an area of cervix about the size of a fingertip. The tissue removed is sent to the laboratory for assessment. Most of the bleeding will be stopped during the operation but it is normal to have some light bleeding or discharge for up to four weeks. You should avoid sexual intercourse and using tampons for four weeks following treatment.

After an outpatient treatment you may have some mild 'period-like' discomfort which you can take paracetamol or ibuprofen for. You should be able to return to normal activity immediately but avoid strenuous exercise for at least two weeks.

The histology report from the laboratory is usually available within two weeks and your doctor will contact you with the results.

Risks of the procedure include bleeding and infection. If you experience very heavy bleeding you should seek urgent medical advice. If you develop any offensive discharge you should contact your doctor as you may need antibiotics

There is evidence to suggest that having two or more loop excisions of the cervix is associated with an increased risk of late miscarriage or pre-term labour in future pregnancies. The risk directly correlates to the volume of cervix removed and does not seem to be associated with a single treatment. For women who are at high risk it advised they receive cervical length scans during their pregnancy and they may benefit from a cervical suture.

Loop excision of cervix is a very effective treatment for removing pre-cancer of the cervix with 98% of women having no residual abnormal cells after treatment. 2% of women will have persistent or recurrent disease after treatment. You will require a cervical smear test six months after the treatment to make sure there are no abnormal cells left and your doctor will arrange this for you.

Vestibulectomy Patient Information

Surgery is rarely indicated or offered in the management of vulval pain disorders.

In a select group of women with a diagnosis of localised provoked vulvodynia, however, a vestibulectomy has been useful in managing the condition and has been shown to have a success rate of up to 80% with careful patient selection.

Vestibulectomy is an operation that removes the lower vestibule (the skin around the opening of the lower half of the vagina). The aim is to remove hypersensitive tissue and replace it with advancement of normal vaginal skin. It involves making a V shaped incision at the bottom of the vagina. The operation is done under general anaesthesia, as a day case procedure. This means you go home the same day and there shouldn’t be a need for an overnight stay. The skin is closed with a combination of dissolvable and non-dissolvable stitches. It is common to have pain and discomfort for a few days or even weeks afterwards and you should take simple painkillers such as paracetamol and ibuprofen regularly until the pain eases.

All operations have some risks. After a vestibulectomy it is normal to have some light bleeding for a few days. Post-operative pain is normal and varies from woman to woman. Sometimes there is swelling and bruising around the vulva but this will all resolve over a few weeks. There is a small risk of infection and you should see your doctor if you notice offensive discharge or pus from the area or if you develop a fever as you may require antibiotics. The biggest risk is that the operation fails to improve your symptoms. Worst case scenario is that your pain is made worse by having the procedure although that is extremely unlikely.

Your doctor will review you four to six weeks after the operation. It is likely that some of the stitches will still be in place at that point and can be removed during your consultation. You will also be examined which gives an indication of how successful the operation is likely to have been and allows your doctor to plan further management.

Vulval Biopsy Patient Information

A biopsy of the vulva can give your doctor extra information if you have a vulval lesion or changes in the colour or texture of the vulval skin. It involves removing a small piece of tissue from the vulval which is then examined under a microscope by a histopathologist.

A biopsy can usually be taken in the clinic setting and takes about fifteen minutes. The area is first cleaned and then local anaesthesia injected to make the area numb. A small circle of skin is removed (less than half a centimetre in diameter). A dissolvable stitch is usually required to stop any bleeding. You will be able to go home and resume normal activities although you should avoid washing the area until the following day.

The local anaesthesia may last for up to two hours. Having a biopsy is a very safe procedure and the risks are very low. Any bleeding can usually be stopped by applying pressure for 20 minutes but contact your doctor if this does not resolve the problem. Occasionally, you may develop an infection and see your doctor if the site is not healing or appears to have an offensive discharge.

The biopsy will take approximately two weeks to be analysed in the laboratory and your doctor will get in touch as soon as the results are available